Doctor says I need to lose some weight. But I have a history of anorexia

December 14, 2013 2:49 PM

I am currently an overweight adult and my doctor has mentioned I could drop some weight. However, I have a history of anorexia and I definitely don't want to go down that path. How to go about losing weight without triggering myself into relapse? Snowflakes inside.

I've been anorexia free for 5.5 years :D I went on some medications about a year ago that ballooned my healthy weight up into unhealthy levels. Before then, my weight had basically been stable. I changed meds, but the weight didn't come off. My doctor and therapist think it would be a good idea to lose some weight but obviously, not to much! My target is right smack in the middle of my healthy weight range, and the important people (doctors, mental health professionals) are on board with this.

The big issue is that I don't want to become obsessed. Calorie counting and food diaries are out. Weighing my food is out. Weighing myself is out (I'd either be weighed by my therapist or doctor no more that 2x a month). I don't want to go to support groups for people with eating disorders as my competition becomes high and I really don't want to hear about people in early recovery/active addiction because it triggers me and I don't want to surround myself with that stuff. I want to be healthy!

Honestly, I want a diet to be as little on my mind as much as possible! I realize that, psychologically when people diet they think about it a good bit, and I'm going to address those issues with my therapist as they arise.

So, I'm looking for advice on non-obtrusive ways to diet. What are things that are easy to do that I can't really obsess over too much? I'm not planning on losing weight quickly or in any time frame, so any small change is worth sharing. Of course, if anyone has been in a similar situation, describing things that have been helpful to you would benefit me.

Thank you.

posted by AlexiaSky to Health & Fitness (20 answers total)

You don't mention your exercise regimen at all. Is it possible to be more active, or are you just focusing on food intake?
posted by roomthreeseventeen at 2:53 PM on December 14, 2013 [9 favorites]

Would some type of meal delivery plan be an option for you? That might be a way for someone else to take care of the calorie tracking and food measuring side of things, so all you'd have to do would be to eat the food you're given. I realize that this isn't feasible for every location and budget, but given your concerns, it might be worth checking out.
posted by Meg_Murry at 2:59 PM on December 14, 2013 [4 favorites]

How active are you? You can lose weight by increasing the amount you exercise.

Another thing you can do is make healthy food substitutions (don't drink soda / juice, eat more fiber and protein so you stay full for longer periods of time when you eat, switch to plain fat free yogurt, and so on). You can also experiment with snacking (honestly, I'm still not clear on whether snacking is regarded as a good or bad thing) to see how that affects your food intake if you think that is something you can do without obsessing over.

Another thing that sometimes helps is having a bowl of thin (not creamy) soup before each mealtime because warm liquid can make you feel fuller earlier on in your meal and you may eat less without having to make a conscious effort.

Good luck!
posted by gemutlichkeit at 3:00 PM on December 14, 2013 [1 favorite]

I read somewhere that giving people smaller plates to eat from makes them eat less without even realising it. Also that using white plates rather than red plates has the same effect. Time to switch up your dishes?
posted by emilyw at 3:00 PM on December 14, 2013 [4 favorites]

I don't have a history of disordered eating, but counting things (calories, meals, grams of blueberries etc.) just doesn't work for me. What worked for me was basically eliminating a category of things: simple carbs. I did keep a diary in the beginning, and it was useful to track that for me, but I don't think it's necessary if you can be mindful (rather than obsessive) about what you're eating.

So, for example, if you usually have pasta for X number of meals, stop eating pasta and eat more veggies and protein and good fats. We used to have mac and cheese a couple of times a week, and switched to simple stir-fry meals instead - lots of veggies, some meat. If you keep sugary snacks in the house, stop, and when you need a nibble go for some nuts or veggies instead. Like that. You don't have to buy special foods or cook from special recipes - just, if you have rice/pasta/bread X times per week, take those out of the equation and eat greens/veggies/meat/fish instead.

But it really depends I think on how your disorder manifested - I've known anorexics who just didn't eat much of anything, and others who ate some kinds of foods but kept huge numbers of other kinds out. Can your doc refer you to a nutritionist experienced in working with people with eating disorders?
posted by rtha at 3:01 PM on December 14, 2013 [4 favorites]

What does your diet look like right now? Are you eating a lot of sugar or processed foods? Those could be the first to go. Maybe focusing on loving the food you eat and knowing that it's good and healthy will be a better fit than some of the other diet practices you specified.

FWIW, I am also a recovering anorexic, and I weigh about 15 lbs more right now than I ever have in my life. I have NEVER let myself gain this much weight before ever. It's seriously tripping me out because while I know I need to exercise and eat better, a part of me is psychologically resistant because my diet right now is me eating because I love myself again. It's sort of like, "what the hell, I spent so many years obsessively monitoring what I eat, and now I gotta start doing it again for my health???? god!". But I know that doing so will be another way I can show myself love, so I'm gonna get there. Solidarity, sister -- we can do this!!
posted by These Birds of a Feather at 3:01 PM on December 14, 2013 [3 favorites]

IANAD but I'd focus on eating a really clean diet, lots of vegetables and lean proteins, few unrefined carbs. Cutting out processed food and upping vegetables will promote general health more than anything else and a lot of people who really clean up their diet lose weight as a by product. Clearly discuss this with your medical professionals.
posted by koahiatamadl at 3:02 PM on December 14, 2013

There was an interesting analysis of two long-term health studies by D. Mozaffarian et al. a couple years ago in the New England Journal of Medicine. The abstract (linked) notes correlations between various dietary and other lifestyle elements and weight gain or loss. It might help to eat more vegetables, whole grains, nuts, fruits, and yogurt, and less potatoes, chips, and meat, without necessarily counting calories or obsessing about quantity. (The smaller plate idea isn't bad, either.)

Another result of the analysis (not apparent in the abstract) is that while the absolute quantity of exercise didn't seem to be correlated with weight loss, an increase in exercise level was. That certainly squares with my own experience at two points in my life when I substantially increased exercise and lost weight - once in my 20s and once in my 40s - without consciously altering what I ate.
posted by brianogilvie at 3:03 PM on December 14, 2013 [1 favorite]

Weight Watchers used to have what they called their "Core Plan" where you didn't have to track points or calories as long as you ate only foods from the Core Foods list which consists of a large variety of foods such as low fat dairy, whole grains, beans, soy, lean protein, fruits and vegetables.

It is easy to stay full on these foods without feeling deprived and still lose weight. The main thing is to eat almost exclusively from the list, and follow the rules of eating only when hungry and only until satisfied but not stuffed.

Weight Watchers no longer offers this exact plan (I believe there is now a similar option called Simply Filling) but there is a ton of information on the old Core plan on this message board thread. I'd start from the oldest posts and work forward, the board has become less active since the Core plan changed to Simply Filling a couple of years ago. I'm sure there is plenty of information elsewhere on the internet as well.
posted by Serene Empress Dork at 3:26 PM on December 14, 2013 [2 favorites]

Best answer: Having had kind of a similar problem, be very careful about your doctors here. It is never worth taking risks with getting sick again to get back to "normal", and a few relapses tend to make it even harder to maintain your health in the future. Don't focus on the scale, whatever the doctor says, but do focus on the general types of food you're eating, and your activity level.

I find that a lot of doctors who do not specialize in eating disorders will be very cavalier with what they suggest with regards to stuff like this and so suggesting a diet at all should probably start some warning bells off here. It is way, way too easy to fall off this wagon. Be careful. You know you better than either your doctor or your therapist knows you; you need to absolutely be in charge of this. It is my experience that if you can find a doctor who understands the Health At Every Size principle, that tends to be a lot safer--and yes, they can still help and encourage you towards the sorts of things that will bring your weight in line with what it should be for you, eventually. But once you've been anorexic, the rate of change is probably going to be an order of magnitude slower than a normal person's. Run from any doctor who criticizes your rate of progress. Just run. Some of my biggest mistakes of my early 20s were believing my doctors just because they were my doctors.

My general principles are like this: Move more, including just things like parking well away from the entrance to stores, as well as a couple hours a week on an exercise bike. Eat more vegetables. Consume less sugar (but not none) and fewer processed foods (but not none). Cook more. Eat out less. With those principles, I weigh myself every couple weeks and as long as the trend is flat/downward, I'm doing fine. I don't track things because I've had trouble with that in the recent past. I've lost... I dunno, maybe 20 pounds from two years ago? It's not a ton, and it's been up and down here and there, but the trend is the right direction and I'm starting to feel much more like myself again. The key is slooooooow. Be the tortoise, because god knows being the hare didn't work.
posted by Sequence at 3:38 PM on December 14, 2013 [32 favorites]

I agree with Sequence in that I think you've asked a very difficult question and I think you need to be very careful about how, and even whether, you follow your doctors' advice.

I think you should not be asking us this question, I think you should be asking a professional with some specialism in eating disorders.

I am tempted to suggest a lot of things, but I think anything I suggest is liable to trigger you and/or do more harm than good. You need specialist help with this.
posted by tel3path at 4:30 PM on December 14, 2013 [8 favorites]

In your situation, I would suggest that you get away from the idea of "weight" being a goal. Weight is not a be-all and end-all when it comes to health.

Instead, just think about getting healthier.

You don't need any measurements... you don't need any huge stress! Just try to take two steps each day.

First: eat healthier, and start by consciously making two or three "healthy choices" per day. Instead of a burger, pick a chicken or a tuna sandwich. Instead of fries, have a salad. Instead of a soda, have a glass of water or an iced tea. Instead of a cookie or a donut, have a piece of fruit for dessert. It doesn't need to be radical, just commit to a couple of changes a day. These will shave calories out of your diet and improve your nutrition, but they'll do so slowly and gradually (which might be good for you).

You can increase the number of "healthy choices" you make over time as you go. Having a limit like that might help you avoid being overwhelmed, or about obsessing over having to eat the healthiest food possible in every circumstance.

Second: be active. Again, start by consciously making two or three "active choices" per day. Instead of an elevator to go up a few flights, take the stairs. Consciously park further away from a store to walk more. Go for a 10-15 minute walk every day. None of these steps are all that stressful or difficult. After a while, you can up your goal so that you are doing four or five or even more "active" things each day. Doctors don't want you to hit the treadmill and run a marathon every day, after all... they're pretty pleased when they hear that patients are taking 20-30 minute walks every day for example... something that is not that onerous or stressful. So just take it easy and do it bit by bit. You'll burn more calories gradually in a way that might not stress you out.

Most importantly though... have you talked to a specialist about this? I would guess that your specialist might echo the advice I am giving you... because our situations are similar, and these steps are what a doctor suggested to me to get started in the right direction.

But you need to talk to a specialist. tel3path is absolutely correct. If you are this concerned about being able to diet and exercise in a healthy way, then this is 100% mandatory. Don't take any of our advice in this thread until you've done that.
posted by Old Man McKay at 5:05 PM on December 14, 2013 [1 favorite]

Response by poster: Thank you all for your responses.

Yes, I am completely in contact with my doctors and those include people who have some specialty with eating disorders. Between my therapist, psychiatrist, group therapist, and doctor all of them are aware and we have had some discussion. When my insurance changes in January, I'll probably be adding a nutritionist to the mix. My doctor is probably the least informed on anorexia. I've made it very clear when my doctor has suggested things that WILL be triggering (like a food dairy) that it is an absolute no-go and I generally take anything diet related to my therapist to run it by her, and I report any emotional difficulty I'm having. I just feel that sometimes it feels silly 'just watch what you eat' and not more productive. Thanks for not listing things you think may trigger. I'd just rather it not be listed at all. After all, I have all these professionals in my life for a reason.

I do need to exercise more (and use that gym membership I pay for!) .

Reading the responses, I'm think why I've been disatisfied with the answers I've gotten from my therapists and such because I want concrete tasks which really no one can provide because healthy isn't concrete.

Thanks again.
posted by AlexiaSky at 5:33 PM on December 14, 2013

Having been overweight my entire life, in the last couple of years I've for the first time had success in losing weight without exercise by cooking very frequently. Not that I never eat pre-packaged foods, but just knowing which ones I can make better or closer to my preferences than can be bought in the store makes me more inclined to cook, and of course you can also make yourself lots of stuff that isn't available in stores. And I can use sugar and salt substitutes at will, or for example lower-carb alternatives like quinoa instead of rice, or just reduce fat-heavy or carb-heavy ingredients.

I might be more suited to this than other people, though, because I like Indian and East Asian food quite a bit; I have all sorts of wonderful vegetable and lentil and low-carb meat dishes and still find an entire meal of that satisfying. It's like having leftovers from a restaurant take-out in your fridge all the time! I also have much more of a taste for heavily seasoned or sharply flavored dishes like bitter melon than many other Americans I know do.

And of course I swear constantly that I'm going to start exercising more and lose weight even faster, but usually don't. One of these days...
posted by Sockpuppet Liberation Front at 7:14 PM on December 14, 2013

AlexiaSky: "Reading the responses, I'm think why I've been disatisfied with the answers I've gotten from my therapists and such because I want concrete tasks which really no one can provide because healthy isn't concrete."

You're right that healthy isn't concrete, and allows for room for variation! That being said, if you find having healthy guidelines helpful to you, a nutritionist who specializes in eating disorders is very much the way to go with this. I had an eating disorder which involved an obsession about eating perfectly healthily, and my nutritionist was very helpful in giving me reasonable yet concrete advice about how to eat healthily without obsessing--and was also supportive and understanding of my concerns in a way that made a huge difference for me. I hope you're able to work with someone equally excellent.
posted by beryllium at 8:07 PM on December 14, 2013

Ok, I've said this before and it's so boring but if you walk for 30 min to 1hr per day then you will lose weight. No impact, no pain, minimal sweating, no diet changes. Walk 1.5 hrs, you will have a whole new body.
posted by bquarters at 9:36 PM on December 14, 2013 [3 favorites]

Do you like sushi? If so, it's on the healthy end of the food spectrum for the most part and super-easy to make. If you do something like California Rolls, you can get all the ingredients in most American supermarkets I've been to, keep them on hand, and have sushi whenever you want, for a meal or a snack! The one somewhat essential tool is a bamboo rolling mat but they aren't too hard to find.

Thumbs up on the walking, too.
posted by XMLicious at 11:06 PM on December 14, 2013

OP gained weight on meds. Yeah there's room in probably everyone's diet to be healthier but I think there's a danger in all the emphasis here that seems to assume that OP's baseline diet hasn't been healthy.

OP, the thing is it seems to me that whatever you were doing before the meds was really very right. You beat your anorexia (which is so huge), sounded like you had a relatively healthy relationship with food and with your body, and maintained a steady weight. Yes, if we all had personal shoppers, cooks, and trainers, it would make sense to reach for some nadir of personal optimization but especially for someone with an eating disordered history, I want to shout from the rooftops how/that 'good enough' is AMAZING.

It sounds like you have a pretty extensive team of professionals but nonetheless I would really really second the recommendation to find a HAES doctor. The evidence for losing weight for health, unless you are currently having weight exacerbated issues (sleep apnea, joint pain, etc) where the results would be pretty immediately obvious, as opposed to the evidence for paying attention to health markers directly, is marginal, and when you have the anorexia history there as well, I'm extremely skeptical that weight loss is a healthy goal for any definition of health that includes mental and emotional health.

It SUCKS that the meds screwed with what was apparently working very well, but don't throw good money after bad (metaphorically).
posted by Salamandrous at 8:57 AM on December 15, 2013 [4 favorites]

would you rather be a little overweight, or anorexic? i don't have personal experience being anorexic, but i know that it is a terrible disease and it's hard to get past. it's AMAZING you have been free of it for 5.5 years. i personally think asking a recovering/recovered anorexic to lose some weight is irresponsible of your doctor. unless you gained like 100 pounds, you are probably better off where you are, than trying to lose weight just to satisfy your doctor and fit his magical bmi hogwash.
posted by misanthropicsarah at 6:47 PM on December 15, 2013 [1 favorite]

Sequence: "Having had kind of a similar problem, be very careful about your doctors here. It is never worth taking risks with getting sick again to get back to "normal", and a few relapses tend to make it even harder to maintain your health in the future. "

Repeated for importance. The very first thing that occurred to me was, "What an insensitive jerk!", followed by "Does the OP's doc KNOW about the anorexic history?"

IF your doc does not know you had anorexia, you need to clue your healthcare-advice-expert in on this important detail!

IF your doc knows you had anorexia, and told you to lose weight anyway without deference to this life-threatening condition, DTMFA! [S]He's incompetent. Period.
posted by IAmBroom at 3:06 PM on December 16, 2013